Minimising disruptions to care for people living with dementia: Northern Ireland

Overview

Owing to the impacts of the COVID-19 pandemic, those living with dementia have experienced a change in their living environments that has exacerbated their conditions. This has led to declines in their wellbeing and the wellbeing of the families and professionals caring for them. By developing new resources to support families and staff, and pivoting to virtual training for staff, Northern Health and Social Care Trust has minimised disruptions to their care and reduced hospital admissions.

Key benefits and outcomes

• Reduction in hospital admissions
• 50 per cent reduction demand for the specialist dementia team after one year
• £94,848 saving in staff time in the first year
• Improved experience for people with dementia and care professionals

The challenge

The number of individuals living with dementia continues to grow as the population of Northern Ireland ages. Around 90 per cent of people with dementia will experience behavioural and psychological symptoms of dementia (BPSD), including aggression, vocalising and exit-seeking, which 30 carers find difficult to manage and can result in escalation of the care provided which frequently serves to exacerbate the individuals BPSD.

Northern Health and Social Care Trust, one of five health and social care trusts in Northern Ireland, has a dedicated team (the Dementia Home Support Team) that supports people living with dementia, their carers and staff in care homes and hospitals. The team implements CLEAR Dementia Care © to avoid unnecessary deterioration which could lead to higher care demand, hospital admission and pharmaceutical management through the provision of training, assessment and recording tools, and supportive materials such as handbooks and guidelines.

Before the pandemic struck, the team’s clinical work was primarily delivered face to face, as were the training programmes it was commissioned to deliver for care staff. COVID-19 changed this. The team was unable to deliver training in person and care homes were required to reduce footfall. At the same time, people living with dementia, carers and staff were experiencing increased distress and needed support more than ever.

Care homes residents were required to isolate in their rooms with no access to family and friends, and little opportunity for social interaction and meaningful occupation. This caused increased confusion and, as the person with dementia did not understand what was happening, their distress increased and there was an increase in behaviours that staff did not know how best to respond to.

Staff had to change the way care was delivered, and the use of personal protective equipment (PPE) impacted on both staff and residents. Staff were off ill or self-isolating and agency staff, who didn’t know the residents, were more frequently employed. There was increased illness and death among this vulnerable population, which impacted on both staff and residents. High levels of uncertainty and anxiety were observed among staff and residents.

The solution

To overcome the challenge of high staff turnover and the impact on BPSD and social isolation, the team developed life story posters and therapeutic letters that provided information about the person. This supported a greater understanding of how their condition might manifest itself, but also supported engagement with the person with dementia that would reduce their social isolation.

In terms of training, the team switched to virtual delivery and reduced class sizes to a maximum of 24 participants. They made use of breakout rooms and developed videos and animations to support training. Together, these changes overcame the reduction in engagement that has been seen when education and training programmes have shifted to online delivery.

Recognising the time demands on carers and staff, the team also reduced the size of training modules, and developed an app that could be used to support learning after the training had been completed. Advice on psychological wellbeing for staff was added to training

Results and benefits

Since the original implementation of the CLEAR Dementia Care model in 2016, evaluation of the service has demonstrated:

• Reductions in experience of distress and an improved quality of life experienced by people living with dementia
• Reductions in hospital admission
• Savings of close to £100,000 in staff time, across 92 care homes
• Reductions in stress levels reported by staff
• Higher levels of confidence and competence among staff when delivering care to individuals living with dementia.

The disruption posed by COVID-19 presented a risk that training availability and quality would decrease, potentially leading to regressions in these positive outcomes. However, evaluation of the training since it moved online has shown no decrease in training outcomes, and so is able to continue effectively supporting these positive improvements in the care provided to people with dementia.

Overcoming obstacles

Engagement from care staff reduced as they were under significant pressure. There were many more agency staff who didn’t know the residents and didn’t know the team. This made engagement harder. It was important for the team to talk to staff to understand how all the changes in care homes were impacting on them.

It was also important that care staff knew that the team were available to support them, not to ask them to do more when they were already stretched.

Introducing brief video and telephone formulation sessions with care staff to enable them to discuss residents helped. Ensuring that care staff knew that the team were aware of the challenges they were experiencing as a consequence of COVID-19 was important.

Recommendations and expectations were tailored, as usual, to the specific needs of the resident, but they also included reference to the environment in which staff were working.

Takeaway tips

• It was important for the team to talk to carers and staff to understand how all the changes in care homes were impacting on them so that care staff knew that the team were available for support them
• Recommendations and expectations were tailored, as usual, to the specific needs of the resident, but they also included reference to the environment in which staff were working.
• Online training and video calls made it easier for staff to access training and support in a flexible way.

Contact details

Dr Frances Duffy, Consultant Lead Clinical Psychologist, Northern Health and Social Care Trust Frances.Duffy@northerntrust.hscni.net